Nimesulide in acute gout flares

Nemish I.L.

Summary. This article analyses the evidence base, pleiotropic effects and safety profile of nimesulide in the treatment of acute gouty arthritis. Gout is a common inflammatory disease whose pathogenesis is linked to activation of the NLRP3 inflammasome by monosodium urate crystals and local overproduction of interleukin-1β (IL-1β). The paper examines the pharmacological features of nimesulide, its weakly acidic properties, which ensure preferential accumulation at sites of acute inflammation, and its moderate COX-2 selectivity. The pleiotropic mechanisms of the drug are presented: suppression of TNF-α production, reduction of matrix metalloproteinase activity, and attenuation of oxidative stress. Cardiovascular, gastrointestinal and renal risks are analysed, together with the features of hepatotoxicity in the context of current regulatory restrictions limiting the continuous course of therapy to 15 days. Nimesulide is positioned as an effective «rescue therapy» in short courses (3–5 days) during the initiation and titration of urate-lowering agents.